16001 (2) POST THIS CARD NEAR FRONT OF BUILDING
. PERMIT NUMBER,
r CITY OF CUPERTINO 16001
INSPECTION DIVISION
� . JOB INSPECTION RECORD
h–/x/,27 ��/,9J�,��]/� PERMIT EXPIRATION
< i JOB ADDRESS I� `" 4& """' ' 'r '_ UNIT# _LOT# PERMIT EXPIRES IF WORK
OWNER [l! ' CONTRACTOR I^ + IS NOT STARTED WITHIN 1
INSPECTION DATE INSPECTOR INSP CTION RECORD 180 DAYS OF PERMIT ISSU-
FOUNDATIONO ANCE OR 180 DAYS FROM
NOTE: LASTCALLED INSPECTION. '
LIFER, fo-tiros 9. f`¢yJ' ALL GRADING AND DRAINAGE SHALL BE INSTALLED .,
PREGUNITE - ,TO COMPLY WITH THE APPROVED PLANS AND CITY OF ,PERMIT VALIDATION
CUPERTINOSTANDARDS.
GARAGESLABS y - /,��—Tp ,y` Y,•t
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED PAID IL
UNDERGROUND /SLAB
PLUMBING SEP 1 5 19 D
ELECTRICAL J J U IssuarvcE untE
MECHANICAL - BLD' ELEcr, PLc MECH.
City of Cupe mjj +�j .
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUIPING PERMIT
WOOD'FLOOR - INFORMATION
PLUMBING va wanoN -SIFT,
MECHANICAL -
ELECTRICAL, .PERMIT TO
FRAMING
INSULATION - STORIES TYPE CONSTR,
>
Q� �_ OCC.GROUP RES,UNITS
a
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED
Sp,FT.FLOOR AREw iOiwL ACREAGE
•• ROOF - NOT NO FI AL INSP.SHALL BE MADE BEFORE '
DIAPHRAGM THE CONSTRUCTION TAX IS PAID 173
BUILDING USE
ROOF SHEATHING HES IND CON 'PB Oma
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INS P. ❑ ❑ ❑ ❑ ❑
A55ESSURS PAHCEL NO, ,
ROUGH SAN,#
PLUMBING {, ELECT.ENERGY `
TUBS B SHOWtR PAN PLUMBING ENERGY TRACTNO. PARCEL NO '
MECHANICAL MECH.ENERGY
ACC.DATE ACC.EAE NO,
ELECTRICAL BUILDING ENERGY
FRAMING ELECT.FINAL TEST
ZONING ENG.SITE NO:
INSULATION �Z PLUMBING ,
GAS TEST GAS —
MECHANICAL FIRE SPRINK ENERGY T 2
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING ❑ N❑ Y ❑ .N❑
'.
_ ' EXTERIOR SHEAR - ELECTRICAL RELEASE FLOOO ZONEAC,U.0
INTERIOR SHEAR' FIRE DEPT. v ❑ N❑ Y ❑ N❑
SHEETROCK �– GRADE FEE SUMMARY
EXTERIOR LATH BUILDING -
INTERIOR LATH TEMPORARY APPROVALS BUILDINGSCRATCH COAT ELECTRIC PLAN CHECK
GAS FEE .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED OCCUPANCY SEISMIC FEE (A
OCCUPANCY 0FBUILDINGIS NOT PERMITTED UNTIL BUILDING FINAL IS SIGNED BY BUI LDING INSPECTOR. MICROFILM
ARRANGE FOR INSPECTION'BY PHONING'252-4505, ` ELECTRIC Do
ONE WORKING DAY BEFORE REQUIRED INSPECTION. ', PLUMBING 0-PLEASE GIVE JOB ADDRESS WHEN PHONING. ;'
- SEE PERMIT FOR EXPIRATION DATE - MECHANICAL . L
IMPORTANT! y .I CONST.TAX
PLEASE READ REVERSE SIDE BEFORE . z,f;
CALLING FOR FINAL INSPECTION. TOTAL fl
OFFICE COPY
APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY . .. -
(�DFNG PROJECT I DENTI FICATION PERMIT NUMBER
BUILD APPLICATION & PERMIT 16 0 Q 1
/ aoDREsk,�
C ' UILDING — ELECTRICAL—PLUMBING—MECHANICAL
OWNER'S PLAN CHECK VALIDATION
NAME ))r DTV. ELECTRIC PERMIT FEE 'T
PHONFQ(v • -P Cp U
CONTRACTOR'S 7 ((//
NAM UTLETS"-SWITCHES-RECEP 1
I� uc.rvo. o� LIGHTING FIXTURES ]II.00/9-00
ADDRESSTOR'SS PPLIANCES-RESIDENTIAL 4.00
CONTRACTOR
-e-�71 ` PHONE 1344 y PANELS 10.00 DATE OF APPLICATION
RCHI ECTPLAN CHECK FEE 'P.C:NO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER
uc.NO. SIGNS TRANS. 3.00
ADDRESS ENG. SPECIAL CIRCUIT 5.00 PERMIT VALIDATION
ZIP EMP.METER OR POLE INS. 20.00 l� -
ADoRessTs MOTORS SEE FEE SCH. 1..
-- SERVICE CHANGE 20.00 G,I15I�
F o o LICENSED CONTRACTORS DECLARATION
aU I hereby affirm that I am licensed under provisions of Chapter 9 ISSUANCE DATE
w "' (commencing with Section 7000)of Division 3 of the Business and
¢ ,� E BLDG. ELECT, PLG. - ME
>w z Professions Cole, nd my license is in lull fore e'. u�/ um/
z o y— License lass Lia Number
0 m Date Contractor
ec m ¢ ¢ OWNIiR BU11.DPR DECLARATIO yF GQ�. BUILDING PERMIT
a o MISC.— REFE o pe III ' INFORMATION
w g u.w I hereby affirm that I am exempt from the Contractor's License VALUATION $/FT.
> LL o J Law for the following reason.(Sec.7031.5,Business and Professions PERMIT ISSUANCE 46:06
Code:Anycity Drcounty which requires a permit to construct,alter, 3•.�¢„D ,��Z
Ie a > ELEC.CONTR. LIC.NO. 3
¢o improve,demolish,or repair any structure,prior to its issuance,also ELEC. /� /�/1
O u requires the applicant for such permit to file a signed statement that TOTAL p�i LtiJ" PERMIT TO
n w es U. he is licensed pursuant to the provisions of the Contractor's License
FI >
Law(Chapter 9(commencing with Section 7000)of Division 3 of tire
¢ Business and Professions Code)or that he is exempt therefrom and OTY. PLUMBING PERMIT FEE
at =$ the basis for the alleged exemption.Any violation of Section 7031.5 STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN -WATER (EA.) 5.00
of not more than five hundred dollars(5500).):
❑ I,as owner of the property,or my employees with wages as BACKFLOW PROTECT.DEVICE 4.00 OCC.GROUP RES.UNITS
their Sole compensation,will do the work,and the structure is not _
intended or'offered for sale(Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5,00
Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who docs such work FIXTURES-PER TRAP SD.FT.FLOOR AREA TOTAL ACREAGE
himself or through his own employees.provided dint such improve-
mentsare not through
or employees,ffered for provided
that such
building GAS-EA.SVSTEM-11NC.40UTLETS 6.00 r.,
or improvement is sold within one year of completion,the owner- GAS EASYSTEM-OVER 4(EA) 200 BUILDING USE
builder will have the burden of proving that he did not build or im - . . .
RES IND CON PB Omer
prove for purpose of sale.). INDUSTRIAL WASTE INTER. 30.00
❑ I,as owner of the property,am exclusively contracting with ❑ ❑ ❑ ❑ ❑
licensed contractors to construct the project(Sec. 7044,Business LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 ASSESSORS PARCEL NO.
and Professions Code:The Contractor's License Law does not apply
to an owner of property who builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1.00
contracts for such projects with a contractor(s)licensed pursuant to SEWER-SANITARY-STORM EA.200ft/10.00
the Contractors License Law. TRACT NO, PARCEL NO.
❑ lam exempt under Sec. ,R&P.C.forthis WATER HEATER WIVENT 6.00
reason
Owner _ Data WATER SYSTEM 5.00 ACO.DATE ACO FILE NO.
WORK ERS'COMPENSATION DECLARATION WATER TREATING EQUIP. 5.00 '
I hereby affirm that I have a certificate of corxent to self-insure, ZONING
or a certificate of Workers'Compensation Insurance,or a certified ENG.SITE NO.
copy therepf(Sec.3600,Lab.0 I ` '(¢
Policy NgfB�,F,_ COlnpanY QIC 1'10
O ❑ Certified copy is hereby furnished. FIRESPRINK ENERGY 734
Z Z Certified copy is filed with the city inspection division. MISC.- REFER TO O . Y Y❑ N
A plicunl ❑ No ,
R RD
rn OF PERMIT ISSUANCE -79-80
LU e CERTIFICATECOMPENSATIONIINSURAON ONCLORKIiRS' PLG.CONTE. LIC.NO. PLG I O� FLOOD ZONE A.LU.C.
CL O (This section need not be completed if the permit is for one TOTAL C�0 iA - Y❑ N❑ Y ❑ N❑
D Z hundred dollars IS 100)or less.)'
U O 1 certify that in the performance of the work for which this per CITY MECHANICAL PERMIT FEE FEE SUMMARY
LL H mit is issued,I shall not employ any person in any mmnner so as to
U become subject to the Workers'Compensation Laws of California.
Q y Date—Applicant Z ALTER OR ADD TO MECH. FSEISMICFEE
3�
} m NOTICE TO APPLICANT If,aNer making this Certificate of Ex-
H ? emplion,you should become suhirct to the Workers'Compensation APPLIANCE 5.00
provisions of the Labor Code, you must forthwith comply with
U such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT(TO 10=CF.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER IO,ODOC.F.M.) 6.00 I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit.is issued(Sec. HEATING UNIT(TO 100,000 B.T.U.) B.00
3097,Civ.C.). M
Lender's Name
Lender's Address HEATING UNIT(OVER 100,000 B.T.U.)9.50 ELECTRIC Z21�
s
s 11 Certify that I have read this application and state that the above VENTILATION FAN (SINGLE) 4:60 O
i, information is correct. I agree to comply with all city and county PLUMBING (�
ordinances and state laws relating to building construction, and BOILER-COMP BOILER-COMP I3IH.P.or 100,000 B.T.U.) 6.00 . I
hereby authorize representatives of this city to enter upon the erllW,tWO BTU)SEE FEE SCH. MECHANICAL 5
above-mentioned property for inspection purposes. Ov
(We) agrees -, indemnify and keep harmless the City of MISC.- REFER TO ORD.
upertino against Iia Units,judgments, costs and expenses which ^ CONST.TAX
ay ini4�ny ay a against mid City in consequence of the PERMIT ISSUANCE _i0:80 GC .
mntitig4fl ' it. MECH. ONE, LIC.NO. MECH.
TOTAL �I
TOTAL 8
I are o p I ant/Contr / Date
OFFICE COPY